Development & Aid, Headlines, Health, Human Rights, Latin America & the Caribbean

ARGENTINA: The Long Adios to Psychiatric Hospitals

Marcela Valente

BUENOS AIRES, Mar 17 2011 (IPS) - Argentina has begun the process of closing down psychiatric hospitals and integrating mentally ill people into the community, like its South American neighbours Brazil and Chile.

Human rights organisations, mental health professionals and patients’ relatives pushed for a new mental health act, which was finally unanimously approved by the Argentine Congress in late November.

The law is in line with the principles of the United Nations Convention on the Rights of Persons with Disabilities, ratified by Argentina in 2008. But all the parties involved admit that enforcing it will be a slow process.

“The law is simply a milestone along the way; implementing it will take time,” national director of mental health Yago di Nella told IPS. “Brazil and Chile, which are the most advanced countries in the region in the field, still have work to do.” Patients’ relatives take a similar view.

Luis Piendibene, head of the Argentine Association for People with Schizophrenia and their Families (APEF), told IPS the law “is modern and progressive, but is not a solution in itself.”

He said it was “essential” to have a national framework law, which had not existed until now. “It’s unbelievable that in 200 years of institutional history, no mental health law was ever passed.”

However, he acknowledged that getting the law to function properly will take “20 or 30 years of team work.”

The new law states that mental health services must be community-based, and promotes interdisciplinary action involving psychiatrists, psychologists, social workers and related professionals.

According to the law, admission to institutional health facilities is a last resort. General hospitals, where patients can be given comprehensive health care, should be used, for short periods.

This decision provoked controversy and was rejected by some psychiatrists’ associations and managers of general hospitals, but it is central to the law, as it entails the gradual closure of psychiatric hospitals.

A number of organisations apart from APEF support the law, including the Centre for Legal and Social Studies (CELS), a prominent human rights group, the Pan American Health Organisation (PAHO) and the Argentine Federation of Psychologists (FEPRA).

But other groups oppose it. The Association of Argentine Psychiatrists (APSA) questions the law’s insistence on team work with other health professionals, claiming this takes ultimate responsibility for the patient’s medication and treatment away from the psychiatric specialist.

APSA also points out that the health system has no alternative to psychiatric hospital admission for patients experiencing a crisis, such as a psychotic episode or a suicide attempt.

But di Nella rebuffed these criticisms. “Nine out of Argentina’s 24 provinces have no mental hospitals left, and in five other provinces there are only a score of patients in the hospitals, which are about to be closed down,” he said.

“We know there are cases where admission (to a hospital) is necessary, not as a form of treatment, but as crisis management,” he said. “Afterwards, there are day centres and group homes for patients who have no family support.”

To meet the new demands, the law provides for expansion of the mental health budget from its present level of one or two percent of the total health budget, to 10 percent, over the next three years, di Nella said.

He added that ending the confinement of patients in mental asylums is not just a question of finances. “It implies a cultural change, a paradigm shift,” and some general hospitals are resisting the changes, he said.

In di Nella’s view, care of mental health patients should be part of the general health service, “but some people still believe that psychiatric patients should be admitted to exclusively psychiatric hospitals,” he complained.

In Argentina, conditions today in public hospitals for the majority of the mentally ill contravene PAHO recommendations and the U.N. convention on disability that the country has ratified.

A study published in 2007 by CELS reported that 25,000 people were confined in psychiatric hospitals. Over 80 percent of these patients had been shut away for at least a year, and many of them had been shut away for life.

Most long-stay mental patients are in asylums for social reasons, that is, they have gradually become isolated from their families, partly because of being in a psychiatric hospital, and now have nowhere to live.

“When patients go into hospital for appendicitis, the family doesn’t abandon them. This problem does not arise with any other specialty,” the head doctor at the José T. Borda psychiatric hospital in Buenos Aires told the authors of the CELS study.

The study, titled “Vidas arrasadas: La segregación de las personas en los asilos psiquiátricos argentinos” (Ruined Lives: Segregation from Society in Argentina’s Psychiatric Asylums), documents cases of “serious abuse and negligence,” such as punishment in isolation cells.

It reports physical and sexual violence against patients, lack of medical attention, unhygienic living conditions, overcrowding, absence of rehabilitation and treatment, and deaths that were never investigated.

At major psychiatric hospitals like José T. Borda, it is commonplace to see patients wandering around in a medication-induced haze, toothless, dirty and lonely, begging cigarettes from anyone who walks past, the study describes.

But such a fate is not inevitable. “As family members, we are convinced that pills aren’t everything, and that a multidisciplinary approach can bring about improvements, even if the illness cannot be cured,” said Piendibene of APEF.

In his view, families can provide the care their mentally ill relatives need, if they are given support.

Piendibene said studies carried out in the United States showed that family members responsible for the care of their mentally ill relatives experience a decline in productivity of between 25 and 50 percent, an indication of the time and effort the role of care attendant requires.

Psychiatrist Hugo Cohen, a mental health adviser for PAHO, welcomed the new law, which is in line with the Caracas Declaration, a regional agreement signed in 1990 and regarded as a watershed in psychiatric care.

Since committing to the Caracas Declaration, Argentina, Brazil and Chile have begun to close mental hospitals as places of confinement. The new law means Argentina can now begin to take more definite action.

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